Enriquez, Salvador v. Defender Services, Inc.

2021 TN WC App. 75
CourtTennessee Workers' Compensation Appeals Board
DecidedSeptember 30, 2021
Docket2020-02-0318
StatusPublished

This text of 2021 TN WC App. 75 (Enriquez, Salvador v. Defender Services, Inc.) is published on Counsel Stack Legal Research, covering Tennessee Workers' Compensation Appeals Board primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Enriquez, Salvador v. Defender Services, Inc., 2021 TN WC App. 75 (Tenn. Super. Ct. 2021).

Opinion

FILED Sep 30, 2021 02:08 PM(CT) TENNESSEE WORKERS' COMPENSATION APPEALS BOARD

TENNESSEE BUREAU OF WORKERS’ COMPENSATION WORKERS’ COMPENSATION APPEALS BOARD

Salvador Enriquez ) Docket No. 2020-02-0318 ) v. ) State File No. 101315-2019 ) Defender Services, Inc., et al. ) ) ) Appeal from the Court of Workers’ ) Compensation Claims ) Brian K. Addington, Judge )

Affirmed and Remanded

The employee requested the trial court to order the employer to authorize knee surgery recommended by the authorized physician. The employer declined to provide the treatment, relying on its medical expert’s causation opinion. Following an expedited hearing, the trial court concluded that the authorized physician’s causation opinion was not entitled to a statutory presumption of correctness because the physician was not selected from a panel. Further, the trial court determined the employer’s physician’s causation opinion was entitled to greater weight than the opinion of the treating physician because his explanation was more thorough and detailed. The trial court denied the employee’s request for relief, concluding the employee did not present sufficient medical proof from which the court could determine that the employee would likely prevail at trial in proving the requested surgery was causally related to the employee’s work injury. The employee has appealed, asserting the trial court erred in concluding the authorized physician’s causation opinion was not entitled to a statutory presumption of correctness. The employer asserts that the employee’s filing of the transcript of the proceedings of the expedited hearing and the employee’s brief were untimely and, therefore, should not be considered. Additionally, the employer asserts the trial court did not err in concluding the preponderance of the medical proof supported its expert’s causation opinion. We conclude the employee’s filing of both the transcript of the proceedings and his brief were untimely and should not be considered. We affirm the trial court’s decision denying medical benefits based on the opinion of the employer’s physician, and we remand the case.

Judge David F. Hensley delivered the opinion of the Appeals Board in which Presiding Judge Timothy W. Conner and Judge Pele I. Godkin joined.

Dan Bieger, Bristol, Tennessee, for the employee-appellant, Salvador Enriquez

1 J. Brent Moore, Nashville, Tennessee, for the employer-appellee, Defender Services, Inc.

Factual and Procedural Background

The facts in this case are largely undisputed. Salvador Enriquez (“Employee”) worked for Defender Services, Inc. (“Employer”), as a machine operator at a factory that fabricated thread. On September 19, 2019, while climbing the steps on a machine he slipped and fell, suffering injuries to both knees. He attempted to continue working for a brief time, but, due to increasing pain, his supervisor ultimately transported him to the emergency department at a local hospital. The medical providers performed x-rays and determined there were no broken bones and referred Employee for orthopedic consultation. Employer provided Employee with two options for medical care, one at a facility in North Carolina and one in Tennessee. Employee chose the Tennessee facility, Appalachian Orthopedics, where he came under the care of Dr. Larry Waldrop. It is undisputed that Employer did not provide Employee with a panel of physicians as required by Tennessee Code Annotated section 50-6-204(a)(3)(A)(i).

Dr. Waldrop provided medical care for Employee’s knees, performing surgery to reconstruct Employee’s left patellofemoral ligament. Employee continued to treat with Dr. Waldrop, who placed Employee at maximum medical improvement several months later, noting that Employee may need knee replacements in the future. In October 2020, Dr. Waldrop noted that Employee was “on an arthritic pathway” and administered a left knee injection “for both diagnostic and therapeutic purposes,” noting in his report that Employee “had significant relief of symptoms from his injection.” He indicated Employee’s “patellofemoral osteoarthritic component is a chronic issue,” adding that Employee “denies any pain prior and is now having increased pain there since the injury.” He further noted:

[Employee] could have developed a meniscal tear in the meantime so I think an MRI would be helpful in determining how his joint status is now. If the arthritis is minimal or he has a meniscal pathology anterolaterally perhaps an arthroscopy would be a little less aggressive than a total knee, but would help in determining that process. . . . He is about as good as I think he is going to get at this point for his left knee outside any other indications and operations.

When Employee saw Dr. Waldrop to discuss the MRI and available treatment options, Dr. Waldrop noted that Employee had left-knee osteoarthritis “post patella dislocation with exacerbation of his arthritic symptoms as far as the left knee was concerned.” He indicated “the plan would be for pain purposes only, a left total knee arthroplasty, which is about the only thing I can offer him at this point,” and stated he would “see [Employee] on an as needed basis at this point.”

Employee returned to Dr. Waldrop in January 2021, continuing to complain of left knee pain. Dr. Waldrop noted that prior X-rays “show osteoarthritic changes throughout

2 the medial, lateral, patellofemoral compartment,” adding that the images taken during the arthroscopy “show patellofemoral disease and pathology present from the time of surgery from the injury.” He ordered a knee replacement, noting that all other treatments only provided temporary relief. Addressing causation, he indicated “[i]t is work related especially the retropatellar space and the treatment would be the same even despite having some degenerative knee issues prior to the injury even if that were the case.”

Employer sent Dr. Waldrop’s recommendation for a total knee replacement to its utilization review provider. On January 29, 2021, the provider recommended certification of the procedure as medically necessary. Employer sought an examination with a physician of its choosing to further address the need for the knee replacement and its causal relation to the work injury.

In March 2021, Employee was examined by Dr. William Hovis, a physician selected by Employer. Dr. Hovis observed severe lateral tracking of the patella in both knees, noting that the condition was associated with advanced severe patella femoral arthritis. Dr. Hovis stated the following in a March 10, 2021 letter to Employer’s counsel:

Given the fact that neither the severe lateral tracking of his patellas is a result of his described work[-]related injury and given the fact that he has secondary severe arthritic changes in the patella femoral portion of his knee joints, it is felt by me that greater than 51% of this gentleman’s previous and current knee problems are a result of a congenital developmental condition in his knee and not the result of one acute knee injury. The severity of the arthritic change in the patella femoral portion of his knee joints simply confirms the fact that he has had longstanding secondary changes in both knees which are the result of his congenital lateral tracking patella mal-alignment. These arthritic changes would not develop to this degree of severity in the period of time from his injury to the current examination. Thus, it is my opinion that his injury represents an aggravation or exacerbation of the pre-existing condition. His pre-existing condition in his knees is also aggravated by his quite significant obesity.

On March 15, 2021, Dr. Hovis sent a second letter to Employer’s counsel, responding to specific questions that counsel had asked in the initial request for an examination. In the second correspondence, Dr.

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Cite This Page — Counsel Stack

Bluebook (online)
2021 TN WC App. 75, Counsel Stack Legal Research, https://law.counselstack.com/opinion/enriquez-salvador-v-defender-services-inc-tennworkcompapp-2021.